NorCal House Dems knock Obamacare repeal vote

The House voted 229-195 today to repeal the “Obamacare” federal health care reforms enacted in 2010 – the 37th time that Republicans have tried to repeal or eliminate funding for the law.

The only two Democrats to vote for H.R. 45 were Jim Matheson of Utah and Mike McIntyre of North Carolina, both of whom represent districts with heavy numbers of Republican voters yet are deemed “lean Democratic” – not “toss up” – by the Cook Political Report. No Republicans opposed the bill.

Like its predecessors, this effort is DOA in the Democrat-dominated U.S. Senate. House Speaker John Boehner, R-Ohio, spoke in defense of the vote:

“Today the House is voting to repeal the president’s health care law because it’s increasing the cost of health insurance, reducing access to care, and making it harder for small businesses to hire new workers. This is the third full repeal vote that we’ve had in the last three years, and some critics have suggested it’s a waste of time.

“Well, while our goal is to repeal all of ObamaCare, I would remind you that the president has signed into law seven different bills that repealed or defunded parts of that law. Is it enough? No. Full repeal is needed to keep this law from doing more damage to our economy and raising health care costs.

“But some progress has been made, and Republicans will continue to work to scrap the law in its entirety so we can focus on patient-centered reforms that lower costs and protect jobs. Because jobs is what this is all about.”

“Here we are, 134 days into the 113th Congress, without one vote on a jobs bill. Fifty-four days after the Senate passed its budget, we still haven’t moved forward to the budget process with this do nothing agenda that does not reflect the priorities of the American people. It is an agenda that only the Republicans are interested in pursuing. So, you see a series of subterfuges, job evasions. Today’s job evasion is that the Republicans have decided to vote on the Patient’s Rights Repeal Act, their 37th attempt to repeal our country’s landmark reform bill. That’s 37 votes, 43 days, $52 million – $52.4 million – on an obvious evasion of our responsibility to work on the priorities of the American people.

“Not only is this a clear waste of time, and of taxpayer dollars, it is a deliberate vote to eliminate the affordable, quality health care benefits millions of Americans are already enjoying.”

Rep. Mike Thompson, D-Napa, called it “a shameful waste of time and taxpayer dollars.”

“Instead of spending more than $50 million to repeal a law that is saving lives and money, we should be working to improve our healthcare system and expand on the benefits the law provides,” Thompson said. “It’s time to put these political games aside. By building on the reforms made in the Affordable Care Act, we can make sure every American can afford to go to the doctor. And that’s what matters.”

And Rep. Ami Bera, D-Rancho Cordova, said Americans “want Congress to focus on jobs, not waste time and taxpayer money voting 37 times to take away patient protections from middle class families.

“The Supreme Court has ruled, and ACA is now law. It’s not perfect, and it’s not the law I would have proposed because it doesn’t do enough to address the cost of care, but we don’t want to go back to a time when children faced discrimination due to pre-existing conditions, when students and young adults were kicked off their parents’ insurance, and when women had to pay more for insurance than men just because of their gender,” he said. “Now we need to move past partisan bickering and start working on ways we can drive healthcare costs down. For years, we’ve been paying more and more for healthcare, and getting less and less. As a doctor and former Chief Medical Officer for Sacramento County, I know there are many places we can find savings.”

Josh Richman

Josh Richman covers state and national politics for the Bay Area News Group.
A New York City native, he earned a bachelor’s degree in journalism from the University of Missouri and reported for the Express-Times of Easton, Pa. for five years before coming to the Oakland Tribune and ANG Newspapers in 1997.
He is a frequent guest on KQED Channel 9’s “This Week in Northern California;” a proud father; an Eagle Scout; a somewhat skilled player of low-stakes poker; a rather good cook; a firm believer in the use of semicolons; and an unabashed political junkie who will never, EVER seek elected office.

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However I think its going to be a huge mess in the initial registration months (October through December)

Actually California seems to have its act together more than most states. Still, even here its going to be rough. It will be in the news every day as the enrollment system begins to operate.
Tens of thousands of newly trained people all trying to help millions of people who know nothing about the choices.

For sure, months fill with chaos.
Millions of people shifting care systems.
Millons of new people covered by Medi-Cal.

IRS ramping up to qualify millions of people for subsidies.

All this coming down the road at 90 MPH.

Repubicans are going to make hay about this night after night on the news. May make a huge impact on the 2014 elections.

Confusion will reign.

JohnW

Republicans are in overdrive to make sure it’s a mess. No funding for outreach and then criticizing the Secretary of HHS for going out and soliciting private funds instead. But the fact remains that there are 60 million people who don’t have access to health coverage through an employer plan or a government program such as Medicare.

Only about 15 million of those buy coverage on the individual insurance market because of either cost or pre-existing conditions. Most of the other 45 million people want coverage and some how, some way will find their way to the private insurance exchanges despite GOP efforts to muddy the water.

I never thought the controversial individual mandate was even necessary, because far more of the people who don’t have coverage want it than don’t want it. That was Obama’s position too during the 2008 campaign. But, once he got into office, he was pressured by the insurance companies and their friends in Congress to go with the mandate.

Elwood

It will be what in the vernacular is called a cluster****.

And how is all this largesse (pre-existing conditions, dependents to age 26, 60 million uninsured) to be paid for?

Where are all the needed doctors, nurses, facilities to come from? Doctors are dropping out of the practice of medicine.

I am a member of the TMTEA party. Taxed more than enough already.

GV Haste

Well there will be growth in usage of medical care to be sure. A study of Oregon’s medicade program showed that when they conducted a experiment.

On the other hand, many of these new folks would otherwise only show up later in emergency rooms and then who do you think paid for that?

Quite aside from the money, the sheer logistics of this transformation over the next 8 months is going to be huge and chaotic. Hopefully California’s transition will be smoother than most states.

Very important in all of this is IF newly legalized undocumented immigrants will be included in any way.
Elements in the state legislature are trying to fund programs that will cover these undocumented immigrants.

I believe Brown is opposing that inclusion, seeing it as a budget buster.

JohnW

@3 Elwood

Glad you asked.

It’s more like 45 million uninsured, because 15 million do manage to get coverage on their own in the mostly unregulated individual insurance market, as dysfunctional and often predatory as that market is. Trust me, I know. The 15 million already covered will migrate to the exchanges (where they will have more choice, transparency and consumer protection). ObamaCare is expected to eventually cover 30 million of the 45 million uninsured.

Staying on the parent’s employer policy up to 26 isn’t necessarily a cost hit. People that age are cheap to cover. And I believe the employer can build any extra cost into the employee’s premium share for dependent coverage, although most won’t. Three million people in this age group have already obtained coverage since this went into effect.

As GV Haste notes, the additional insured will reduce the amount of care provided in expensive ER’s and the cost shifting from the uninsured to the insured.

As for pre-existing conditions, this levels the playing field. If you get coverage through an employer for yourself and dependents, you get it regardless of your health status. Older employees don’t pay more than young employees, and sicker employees don’t pay more than healthy ones. Females don’t pay more than males. Only people who have to get insurance on their own have been subjected to that discrimination. The health insurance exchanges are designed to create the type of risk pools that people in employer plans have always enjoyed.

But will this cost taxpayers? Yes. Because people up to certain income levels will be eligible for premium support (similar to what Paul Ryan proposed for Medicare). Personally, I think the subsidies are too generous in terms of the level of income you can have and still get premium support. On the other hand, if you are elderly and on Medicare, you are subsidized big time. If you get coverage through an employer, you are subsidized because the employer’s cost of providing that coverage is not included in your taxable income. You don’t get any tax break when your buy insurance on your own with your own money. Why should the people who buy insurance on their own be the only ones who don’t get subsidized?

I don’t buy the argument that shortage of providers is a good reason to not expand coverage. Talk about health care rationing! Sorry, no room left in the lifeboat – drown! The market will eventually adjust. I think what we will see is more primary care docs going to work for hospitals, large group practices and organizations like Kaiser, so that they can get a good salary, practice medicine and not have to deal with the headaches of private practice.

And let’s not forget that the countries that have some form of universal coverage spend far less per capita and as a percentage of GDP than we do. Socialist fools! We’ve got the best doctors, the best medical schools and most of the top tier medical centers. But we’ve got a really stupid hodgepodge delivery system. Unfortunately, ObamaCare adds on to that hodgepodge rather than giving the system the enema and reconstructive surgery it needs.

Publius

This is what happens when one party unilaterally passes a major bill with absolutely zero support from the opposing party. There has been more bi-partisan support in its repeal than its passage. The way this bill was rammed through using parliamentary tricks will forever curse it. Despite all of the free stuff this act gives to the wanting this bill is more unpopular today than it was in 2010.

JohnW

@6 Publius

“The way this bill was rammed through using parliamentary tricks.”

Yes, indeed, that old reliable parliamentary trick known as a majority vote.

There are things about this law that I don’t like, including the manner in which it is financed. They should have just gone to a series of regional insurance exchanges, instead of this mishmash of state-run and federal exchanges. And I would have found a way to do it without the individual mandate (a Heritage Foundation and Newt Gingrich idea implemented by Mitt Romney as his launching pad for a presidential run in 2008).

I would love to have seen a law that had at least some GOP backing. It might have been a less ambitious plan, but it would have had bipartisan support and provided a building block for progress later. It would have avoided all the “death panel” nonsense. Problem is, Republicans had no intention of engaging on anything dealing with health care. There was no Republican support to be had on any kind of plan. If Obama had proposed 2 aspirin and a good night’s rest for low income cancer patients, Republicans would have called it a government takeover of the health care system.

They wanted an issue for 2010, and they made one happen with all the phony town hollering meetings. They knew from the 2008 Dem primaries that health care was the Dem’s signature domestic issue and planned from the beginning to demagogue it no matter what the Dems proposed. Dems helped by having bills written by 5 separate congressional committees.

GV Haste

I’m all for the general concept of Obamacare.
I will benefit. I now self insure with Kaiser at $610 per month (that with $50 co-pays for office visits and no drug coverage)
I spend so much on my monthly payment that I can’t afford to see the doctor for a extra $50 unless its something very important.

The time between, enrollment opening, October 1st and the end off the first 6 months of the new plans, July 1st 2014, are going to be brutal.
California may be one of the most prepared but it will still be chaos. Other states are so confused they may postpone it for a year.

A couple of HUGE problems with the system.

Employers with less than 50 employees don’t have to offer coverage. Expect many companies with 60 or 70 employees to drop employees, or hire them as independent contractors.

Employers don’t have to provide health care to employees with health care if they don’t work 30 hours a week. Expect huge numbers of 29 hour a week employees to become the norm.

Walmart, and loads of others retailers will have 4 x 7 hour employees, or some variation.
Then those employees will have to get health care on the exchange at a reduced rate.

I wouldn’ doubt that Obamacare will be issue #1 in the 2014 congressional elections.

One nice feature for those 55 thru 64, is that not only will they not have to fear pre existing conditions, but the cannot be charged more than 3 times what a 20 or 27 year old can be charged.
High, but not insanely high. No more of the $1,600 per month horror stories for skimpy coverage.
Or the simple “high blood pressure” exclusions from coverage. Not to mention a prior bout of cancer wherein NO ONE would even discuss coverage.

Also, depending on how immigration reform plays out, the whole issue of health care for undocumented workers is huge, especially in California.
At least $700 million huge per year. Probably much much higher in reality.

JohnW

@8 GV Haste

All your comments about the benefits, hurdles and politics of ObamaCare are spot on. We’ll just have to see how it plays out. I wish you luck.